1 to 1 Centre-Based ABA Services Inquiry Form - Strides Toronto Autism and Developmental Services

The focus in 1:1 Applied Behaviour Analysis (ABA) is on building meaningful skills through structured activities, practice, and positive support, with guidance from a clinical team to ensure therapy is tailored to your child and adjusted as they grow and make progress.

Child's First Name

Child's Last Name

Parent's First Name

Parent's Last Name

Email Address

Phone Number

Preferred Response

Email
Phone call

Address

Address Line 1

City

State / Province / Region

Postal Code

Does your child have a diagnosis of Autism?

Yes
No

Are you registered with the Ontario Autism Program (OAP)?

Yes
No

OAP Number

How old is your child?

To better understand your child’s needs and recommend services that are best suited for your child, please answer the following questions:

1. How does your child communicate?

Does not speak (e.g., cries, points, or pulls)
Does not speak but uses an alternative communication method (e.g., picture exchange, communication device)
Speaks in 1-2 word phrases
Speaks in full sentences, but may need support with having a conversation
Speaks fluently and can speak about events from the past or future

Please select one.

2. Does your child engage in challenging behaviors that could require 1:1 support?

Elopement (i.e., runs away from you without informing you)
Aggression (e.g., hits others, bites others)
Property destructions (e.g., throws items, rips/ tears items)
Self-injurious behaviours (e.g., hits self, bites self)
None of the above

Please select all that apply.

3. What is your child’s current school placement?

Regular classroom with no additional supports
Regular classroom with some supports (e.g., IEP, consultative services)
Regular classroom with resource or withdrawal assistance (i.e., instruction from a special education teacher for parts of the school day)
Specialized small group class placement (e.g., MID classroom, DD classroom)

Please select one.